Purpose:

Specialty and subspecialty medical training programs must provide trainees a wide and balanced exposure to clinical entities. Although university-based programs usually allow residents to learn the evaluation and management of unusual and difficult cases, they do not always provide the required experience to manage common and less complicated medical conditions which are usually seen at community-based medical facilities. Few studies have addressed these concerns. The aim of this study was to compare the rheumatology practice profiles of a university setting and two community-based rheumatology practices.

Methods:

Claim forms submitted from rheumatology practices to healthcare insurance companies in 2007 were evaluated. The university and community settings were located in the same geographic region of a United States city. The university setting has an accredited Rheumatology Training Program by the Accreditation Council for Graduate Medical Education and fellows had clinical exposure to all rheumatology services provided by the institution. Demographic parameters, primary diagnoses (per International Classification of Diseases, Ninth Revision), type of patient visit and rheumatologic procedures (per Current Procedural Terminology-4) were examined. Variables were analyzed by chi-square and Student's t tests.

Results:

A total of 8,153 claim forms were evaluated; 1,893 from the university setting and 6,260 from the community practices. The demographic features, type of patient visit, rheumatologic procedures and primary diagnoses are shown in the table below.

Feature

University (n = 1,893)

Community (n = 6,260)

p value

Age, mean years (SD)

45.4 (15.3)

55.7 (16.2)

<0.001

Gender, % women

88.3

88.5

0.002

Office visit, %

89.9

99.7

<0.001

Emergency room visits, %

0.5

0.0

<0.001

Hospital visits, %

9.2

0.2

<0.001

Joint injections, %

3.0

10.4

<0.001

Soft tissue injections, %

1.7

5.3

<0.001

Rheumatoid arthritis, %

17.2

11.4

<0.001

Systemic lupus erythematosus, %

39.6

14.0

<0.001

Scleroderma, %

3.4

0.6

<0.001

Sjögren's syndrome, %

0.4

2.2

<0.001

Inflammatory muscle disease, %

2.4

0.4

<0.001

Polymyalgia rheumatica, %

0.3

1.2

<0.001

Unspecified connective tissue disease, %

3.0

8.1

<0.001

Vasculitic syndromes, %

2.6

0.8

<0.001

Spondyloarthropathies, %

1.4

0.9

0.047

Osteoarthritis, %

10.1

19.3

<0.001

Gout, %

1.4

0.2

<0.001

Fibromyalgia syndrome, %

2.0

7.0

<0.001

Regional rheumatic pain disorders, %

1.5

8.0

<0.001

Low back pain, %

0.4

5.8

<0.001

Conclusion:

Several differences were found in the rheumatology practice profile among patients seen at the university and community settings. This study suggests that efforts should be undertaken to provide a more rounded and diversified patients' exposure to rheumatology fellows at this institution.